The Opioid Crisis

December 16th, 2017

Right now in the US, there are record numbers of deaths attributable to overdosing on opioids.  The situation is so bad that even medical examiners, who perform autopsies on the victims, are leaving their profession out of exhaustion as reported in The New York Times.  In the past and even today, society associated opiate abusers with low income and urban areas.  The current crisis is different since there are no boundaries.  Rich, poor, every ethnicity, education level, urban or rural is impacted.  I want to make one point clear:  Just because someone is addicted to opiates does not mean the person has poor willpower or that they willingly entered into that lifestyle (the same can be said about people who are obese).  Opiate addiction is primarily the result of a complex chemical/hormonal imbalance and/or genetic predisposition, which can be triggered by even one instance of taking opioids.  Sadly, most of the people addicted did not start with “street drugs” such as heroin.  They were likely introduced to opiates through valid prescriptions by healthcare providers.  Another point I’d like to make here is that just because something is a “prescription” does not make it any safer than any other medication that causes addiction.

How did we get to this situation? Well, I remember in my training that we were told to make sure pain was treated at all costs.  Pain was the enemy of any good healthcare worker.  I recall being taught about asking patients to rate their pain from 0-10, with 10 being extreme pain like childbirth.  For extreme pain, they suggested opioids, such as oxycodone, morphine, or percocet to name a few.  Sadly, opioids are still being overprescribed today.  To make the situation worse, the pharmaceutical companies have developed very potent opiates which are more likely to cause overdoses.  Unlike other drugs, one course of opioid medication can lead to getting “hooked”.  There are a multitude of stories about people who have had surgery and were handed a bottle of opioid medication to take home for “pain” and then ending up overdosing on medication months or years afterwards.

Here are some tips on how you can protect yourself and your family from this crisis:

• When visiting your healthcare provider with any complaints of pain, ask what medications that are non-narcotics can be taken.  Cool compresses, and topical creams/patches such as capsaicin can be helpful as well.
• Acetaminophen and NSAIDS (ibuprofen, aspirin, and naproxen) can be highly effective for pain at higher doses.  In fact, one study found that the combination of Acetaminophen + Ibuprofen was just as effective as opioids without the potential for addiction.  Ask you healthcare provider about what is the best regimen for you.
• Don’t pressure your healthcare provider into prescribing opioids.  I recall hearing from a patient, “I’ve tried all the over the counter pain medications, I need something stronger so I can sleep.”  When I asked further what medications she tried and she took it, she said she just took 2 tylenol (650 mg ) the night before and Advil 1 tablet that morning.  I informed her that it was not surprising she was not having relief. She wasn’t taking enough of either medication to really make a difference!  Tylenol (acetaminophen) can be safely taken up to 4000 mg (2000 mg if you have any liver issues) in a 24 hour period!
• Establish a plan with your healthcare provider to find out when there may be a benefit for taking opioids.
• If you or your loved ones do require opioids, have an open and honest discussion with the healthcare provider and insist that you start with the lowest possible dose, fewest number of pills, and weakest forms of opioids.  There is a dramatic difference in potency of opiates available, ranging from codeine which is often combined into a cough syrup, to fentanyl, which is so powerful that even accidentally inhaling pill dust can result in significant effects!
• If you are prescribed opiates, make sure you do not keep remaining pills “for a rainy day”.  Studies have shown that many adults who have opiate addiction started when they raided their parents’ medicine cabinets.  Do not flush the pills down the toilet and do not throw them out in the garbage as that can lead to the environmental contamination.  The best way to dispose of the pills is to bring them to a pharmacy or medical office for safe disposal.  As I mentioned earlier, always ask for the fewest amount possible (no more than 1 week’s worth, so you won’t end up having too much leftover).
• There are medications for overdose that can be administered without medical supervision.  If you or someone is prescribed opiates or you suspect someone in your household is using opioids, you may want to find out about learning how to administer them and keeping these in the house.  These can be as simple as a nasal spray (Narcan nasal spray).
• If you suspect someone you know may be abusing opioids, try to get help for them.  Here is a link to locate a service nearby.  It’s never too late, you may save their life!